CEFUROXIME SODIUM
Clinical safety rating: safe
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
Cefuroxime sodium is a second-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking.
| Metabolism | Cefuroxime sodium is not metabolized; it is eliminated unchanged primarily via renal excretion. |
| Excretion | Renal (95% unchanged via glomerular filtration and tubular secretion); biliary/fecal (minimal, <5%) |
| Half-life | Terminal elimination half-life: 1.2 hours (range 1-2 hours) in patients with normal renal function; prolonged to 15-22 hours in end-stage renal disease (CrCl <10 mL/min); dosing adjustment required for CrCl <30 mL/min |
| Protein binding | 33-50% bound to serum albumin (primarily) with moderate binding |
| Volume of Distribution | 0.13-0.23 L/kg (or 9-16 L/70 kg); distributes well into pleural fluid, synovial fluid, bone, soft tissues, and CSF (only with inflamed meninges) |
| Bioavailability | Intravenous: 100%; intramuscular: approximately 100% (rapidly absorbed); oral (cefuroxime axetil prodrug): 30-50% (not applicable for sodium salt). Note: Cefuroxime sodium is not administered orally. |
| Onset of Action | Intravenous: 20-30 minutes for bacteriostatic effect; intramuscular: 30-60 minutes for peak serum levels; oral (cefuroxime axetil): delayed, not applicable for sodium salt |
| Duration of Action | Duration of bactericidal serum concentrations: 6-8 hours (dose-dependent); clinical effect persists 12 hours for susceptible pathogens; longer with renal impairment |
| Action Class | Cephalosporins: 2nd generation |
| Brand Substitutes | Spectraxime 750mg Injection, Travexel 750mg Injection, Ocef 750mg Injection, Cefbet 750mg Injection, Cefoxim 750mg Injection |
750 mg to 1.5 g IV or IM every 8 hours; maximum 6 g per day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl >20 mL/min: no adjustment; CrCl 10-20 mL/min: 750 mg every 12 hours; CrCl <10 mL/min: 750 mg every 24 hours. |
| Liver impairment | No adjustment required for hepatic impairment. |
| Pediatric use | Neonates: 10-25 mg/kg IV/IM every 12 hours; Children >3 months: 15-30 mg/kg IV/IM every 8 hours; maximum 600 mg/day for neonates, 6 g/day for older children. |
| Geriatric use | Adjust based on renal function; monitor for superinfection. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
| FDA category | Human |
| Breastfeeding | Excreted in breast milk in low concentrations (M/P ratio approximately 0.25). Considered compatible with breastfeeding; monitor infant for diarrhea or rash. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies. Human data limited; considered safe in pregnancy. Avoid first trimester unless necessary. No reported fetal risks. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to cefuroxime or any cephalosporin","Hypersensitivity to penicillins or other beta-lactams (relative, due to cross-reactivity)"]
| Precautions | ["Hypersensitivity reactions (including anaphylaxis): use caution in penicillin-allergic patients","Clostridioides difficile-associated diarrhea (CDAD)","Seizure potential with high doses or renal impairment","Bleeding risk due to hypoprothrombinemia (rare)","Renal function monitoring required; dose adjustment in renal impairment","Superinfection with prolonged use"] |
| Food/Dietary | No significant food interactions. Avoid alcohol due to potential disulfiram-like reaction with metronidazole co-administration. |
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| Fetal Monitoring | No specific monitoring required beyond standard adverse effects. Monitor for allergic reactions, Clostridioides difficile colitis, and renal function if high doses. |
| Fertility Effects | No known adverse effects on fertility in animal or human studies. |
| Clinical Pearls | Administer IV over 30 min; avoid IM in severe infections due to pain. Renal dose adjustment required for CrCl <30 mL/min. Cross-reactivity with penicillins in 5-10% of patients. Contraindicated in cephalosporin hypersensitivity. |
| Patient Advice | Complete full course even if you feel better. · Report any rash, itching, or difficulty breathing immediately. · May cause diarrhea; contact doctor if severe or bloody. · Avoid alcohol for at least 72 hours after last dose due to disulfiram-like reaction risk. |